Stigma

How Self-Stigma Happens

Corrigan and Rao's model for how self-stigma happens

Public stigma, involving prejudice and discrimination from outsiders that’s directed at us, is damaging enough as it is. But sometimes that stigma gets internalized into self-stigma, an unpleasant gift that keeps on giving.

How self-stigma develops

Researchers Patrick Corrigan (my academic crush) and Amy Watson described three broad types of reactions by people who are impacted by stigma: righteous anger, apparent indifference, and self-stigma.

A paper by Corrigan and Rao described a 4-stage model for how self-stigma develops in someone with a mental illness:

  1. There is an awareness of public attitudes and the stereotypes that go along with them – aka “I know what they think”
  2. There is an agreement with those public views and stereotypes – aka “I think they’re right”
  3. Those beliefs are applied to the self, and stereotypes are incorporated into the self – aka “I think they’re right about me”
  4. Behaviours are impacted in a harmful way; often, this takes the form: because of [stigmatized belief], I am not [worthy, able], so what’s the point even trying – aka “I’m fucked”

There are multiple factors that determine how a given individual reacts to stigma. The combination of low self-esteem and high perceived legitimacy of stigma makes people more likely to develop self-stigma.

On the other hand, people who have low perceived legitimacy of stigma, intact self-esteem, and strong identification with their social in-group (i.e. others with mental illness) tend to respond to stigma with righteous anger. However, if that combination is changed up and group identification is low, then there’s an increased likelihood of an indifferent response to stigma.

Other factors that come into play include:

  • the belief that stigma arises from unjust social pressures
  • cultural stereotypes
  • individualist vs. collectivist ideologies
  • attribution of positive and negative events to internal or external factors

Negative effects of self-stigma

Self-stigma tends to decrease self-esteem and self-efficacy.  Quality of life and health outcomes tend to be worse.  The why-try effect mentioned earlier acts as a barrier to achieving goals. Increased self-stigma has even been linked to increased psychiatric hospitalizations in a study by Rüsch and colleagues.

There can also be disruptions in identity and sense of self that arise from perceiving oneself as part of a stigmatized group. This can lead to increased anxiety and vigilance. It’s an interesting counterpoint to the benefits of strong group identification in preventing self-stigma from developing in the first place.


Ways to decrease self-stigma

Empowerment decreases self-stigma, and peer support can boost empowerment.  Peer connections in some form can also promote stronger group identification, which in turn has protective effects against self-stigma and tends to promote a righteous anger response.

“Coming out of the closet” can decrease impact of self-stigma on quality of life. An analogy Patrick Corrigan often makes is to coming out proud in the LGBTQ+ community. While it’s something that can be challenging on an individual level, on a broader social level, it can have a significant effect.


My own experience

When it comes to righteous anger vs. self-stigma vs. indifference, I fall squarely into the righteous anger camp. I rate stigmatized beliefs as having very low legitimacy (aka a steaming load of BS), and at least in part, this came from working in mental health care and having a reasonably good understanding of the reality of mental illness. I’m also inclined to be pro-medical intervention because of my professional background. I tend to view the world through a social justice lens, which I think also lowers the perceived legitimacy of stigma.

It probably also makes a difference that I first got sick as an adult, when I already had a strong sense of identity and self-esteem. I chose to “come out” early on; in part, that was because I had no control over certain people knowing, and I figured the best way to regain control would be radical openness.

In-group identification wasn’t that much of a thing until I started blogging, because, at least for the most part, my social interactions were not with others who had a mental illness. I was already strongly rooted in the righteous anger response, but I think it would have been very helpful to have been aware of the availability of this sort of online community in the early days of my illness.

Has self-stigma been an issue for you? What do you think may have influenced that?

References

You can find more about mental illness stigma on the Stop Stigma page.

28 thoughts on “How Self-Stigma Happens”

  1. Very interesting article! It has answered many of the questions that I’ve been having for some time.
    I am gay and self-stigma is a very common phenomenon among gay men – and the 4-stage model that you have shared perfectly describes the whole situation that I’ve been going through. I mean not personally, because I have always been told to accept and to love myself but those members of the LGBT+ community who were raised in more conservative families often end up literary hating themselves for being gay 🙁 and well… dating a person who have stigmatized belief can be really challenging.
    Another example of self-stigma – that i have personally experienced – is the feeling that I have about still living with my parents. Before the COVID19 situation began, I used to travel a lot so I didn’t really feel the need to have my own place and I thought it was better to save as much money as I can instead of spending it on rent. And well, I have a great career, my own property in the countryside and I am pretty much enjoying life living in the city center. But despite that, society has started to make me feel as if I was a loser. Like – rationally thinking, I really think that spending over half of my salary on rent (expensive in here) while spending only few days a month at home wouldn’t make sense at all – especially because I would only be able to rent something in a neighbourhood that’s significantly worse than ours – but because of the reaction of people who make faces when I tell them that I am 27 and still living at home, I will always feel that I am a loser and that they’re right about me.

    Thanks for sharing this. Really helped! 🙂

    Cheers

    Mark

  2. I think stigma is weird for me, because I usually don’t pick up on it. I’m not sure why. I did have one experience once where I was applying to work two nights a week overnight on a mental health unit, and they were going to hire me until I filled out the healthcare questionnaire. I put that I’m schizophrenic (and so on, and so on) but that I don’t regularly deal with depression. The HR guy freaked out so badly that he misread what I wrote and asked me to tell him more about the depression I experience. [Facepalm.] That was flagrant discrimination, so I told him my dad’s an employment lawyer, and he got a panicked look. I think after that point, he did whatever he had to to give the impression that he was just following policy, or something.

    But aside from that, I haven’t encountered more stigma. I’m more likely to encounter people who try to treat me like I’m NORMAL, which is weird. Employees who say hi to me at the drug store even though I swerve to avoid getting too close to them due to my fears of energetic pollution. That sort of thing.

    I sometimes wonder if I’d judge mentally ill people if I myself were the picture of optimum mental health. What would I conclude about them? That they should keep taking their meds instead of ruining lives by going off of them? (As a mentally ill person, I have an intuitive understanding of why people make that choice.) That they should keep trying to find solutions, because how hard could it be? (And I can tell you that it’s definitely NOT that easy. It can take years and years to get the right meds and diagnoses.) That they should quit blaming a bad childhood for their adult lives? (We all know about my childhood, so hot damn.) It scares me that Alternative-Reality-Happy-Life-Meg could have those judgmental beliefs, and so I try to put myself into other people’s shoes for comparable issues that I don’t necessarily struggle with (addiction, being unable to let go of toxic relationships, porn addiction, etc.)

    Generally when I encounter people who seem to freak at my diagnoses, they don’t become people who are going to be around for long (and that’s usually their choice, not mine). I tend to think that people who stigmatize the mentally ill are too small-minded to understand the nuance of human experience. And for that reason, I try to shut up my own inner judgmental voice about other experiences that I don’t have. I’m a total open book about my issues, and I guess that’s because I’m not ashamed of the diagnoses–but even stuff I am ashamed of, I’ll talk about to people. I guess I think shame is the enemy that needs to be destroyed.

    I think my campus counselor might have been treating me with stigma. I’m not sure. She helped me through my five-year college career by counseling to me once a week, but when I tried to see her again around five or seven years later, she got this panicked look when I described my problems to her and mumbled that she didn’t know of any resources within the community that could help me, and then she showed me the door. I’m not sure if that would qualify as stigma, or if she just didn’t want to deal with my problems.

    Great blog post! I’m now ready to start my day in style.

  3. I loved this post on self-stigma. I have definitely experienced it over the years largely in the form of low self-esteem but did not have the name. Thank you for naming it. That is the first step in addressing it – I am guessing.

  4. I think I have a lot of self-stigma, partly about my depression and social anxiety, but also about autism, paradoxically, often combined with “Maybe I’m not really on the autism spectrum and I’m just a freak” thoughts.

    I suppose that, like a lot of people on the spectrum, well-meaning adults socialised me to think that I shouldn’t do the things I wanted to do or think the things I wanted to think. That I shouldn’t stim and I should force myself to talk to people because “it will get easier if I try” among other things. Maybe they were right about some of these things, but I guess the cumulative effect is to make me doubt myself and to feel that there is a “normal type of person” and that my behaviour as a depressed autistic person is abnormal and that this is wrong in itself and responsible for many of my issues, such as unemployment, singledom and loneliness. If only I could stop being a “freak” (one of my favourite terms for myself, you may have noticed) and become “normal,” all my problems would be solved.

    Of course, none of the authority figures in my life had any knowledge of high functioning autism when I was a child; the diagnosis of Asperger’s Syndrome (as it was called) didn’t even get into the DSM until I was eleven and wasn’t well-known for many years after that.

    Even now I make more eye contact than many people on the spectrum even though my natural preference, like many autistic people, is to avoid eye contact. This is because I was told to make eye contact as a child and I internalised that message (not knowing about autism at that age) so I very consciously force myself to make eye contact, and usually quietly freak out in my head about making too much eye contact, or too little, or the wrong type; if I feel I’m not making enough eye contact, or too much, I blame myself rather than accept it.

    1. Yeah, I’ve noticed the freak term, and I’d say there are a lot of “normal” people who are light years beyond you in freakishnness.

      It’s really unfortunate the damage that adults can do in an attempt to shape children’s experiences and behaviour. I’m lucky that in my home growing up independence was valued and there wasn’t a lot of pressure to be a certain way.

      I very rarely make eye contact now. It’s part of the psychomotor retardation package deal, but it feels like there isn’t enough brain power for making eye contact at the same time as doing anything else.

      1. I think I’m more freakish in person than online (I’m certainly less socially adept in person), but, yes, there probably are more freakish neurotypicals out there.

  5. There’s a lot of stigma around the BPD term and people in my field (and others) have used the term borderline in highly stigmatizing ways. Since my self-esteem has never been particularly stellar, sometimes I buy into their thoughts and other times I know that the label of BPD isn’t what makes me who I am. I guess I’d fall somewhere between self-stigma due to my core beliefs and righteous anger due to the frustrations I have of people mistaking BPD for this horrid diagnosis that means the worst of someone.

    1. It’s really quite disgusting how much stigma that exists in in professional circles around BPD. My guess is that people lack the skills and then rather than taking ownership, project crap onto people with BPD.

  6. This was really interesting.I’m certain I internalize a lot of stigma and although I can understand when I’m being stigmatized by others and I know they shouldnt do it I still feel that I deserve it somehow.

  7. Awesome article! I know I’ve experienced a lot of self-stigma and I continue to. It has made it tough when it comes to self-care because I often feel like I don’t deserve it, or I should just tough it out. For me, it came from how I was treated when I was first going through my illness as a kid, it was a “learn to deal with it yourself” situation, with what felt like little to no sympathy or understanding. Aside from my natural inclination to deal with my issues myself unless it’s an emergency, others in my life assumed that a teen could deal with mental illness on my own.

  8. When I was a chubby little girl I reacted to the fat-phobia at the time by developing anorexia. This defined my life for a decade or so even when I looked “normal” again after gaining 20 pounds so I wouldn’t die. For many decades, I also reacted to my perception that it was a failure to be single. I desperately tried to make relationships work, and later after my long marriage failed, I dated like mad. But now, finally, I’m more chilled about being single. Turns out, so many are!

  9. Fascinating post! I have a lot of self-stigma, and didn’t realize there was a term for it!! A lot of my self-stigma is about being a reserved and serious person, because American culture (especially corporate culture) treats being reserved as a sign of weakness/worthlessness.

    1. It’s so ridiculous the things people get judged for. There’s no reason to expect us all to be cookie cutter versions of whatever is supposedly “normal.”

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